by Dianne Drake
Pulling herself a little closer to Delroy, Sarah reached across his body, trying as best as she could to make an assessment of other injuries, but it was difficult, given that she was so far away and still in such an awkward position. She decided that once she reached his head she’d try to get over to the other side to do the same exam as she’d done on the right side.
“Pupils?” someone called from behind her. Somewhere not under the bus.
“Haven’t assessed them yet. Don’t have a light.” The voice was familiar, but it was hard to tell through the noise of the crowd.
“It’s on its way,” the man shouted. At that moment a small flashlight was thrust, with some force, under the bus, and she grabbed it, grateful that a medic had finally arrived on the scene. Now, if only she had enough room to push herself up to her knees for this. But she didn’t. This was an exam she had to do either on her belly or her side.
“Are you medical?” he yelled. “Do you need help under there?”
Was it Michael? It sounded like him, and she prayed that it was. She needed someone she trusted, needed someone who was calm to help her get through this. “Michael Sloan?” she called. “It’s Sarah. Sarah Collins, from the ship.” Gently pushing back one of Delroy’s eyelids, she flashed the light in his eye to see pupillary reaction. She studied it for a moment, then did the same for his other eye. Not responsive to light. A very bad sign. “I think we have a head injury here. His pupils aren’t equal and reactive to light. He also has a broken arm, not a compound fracture, though. At least, that’s the best I can tell. And that’s all I can see so far. Oh, and there’s not enough room for two of us.”
“Sarah,” he called, crouching at the edge of the bus.
She glanced at him for a moment, glad to see his face, even though it was streaked with worry. “I don’t suppose I mentioned that I’m a doctor, did I?” she asked, knowing full well she hadn’t. These days, if it didn’t come up in conversation, she didn’t bring it up. Even in the company of another doctor. Especially in the company of another doctor. That made avoidance all the more easy.
“Do you need a cervical collar?” he called back, rather than responding to her confession.
“To get him out, yes. And a backboard.” She did a quick check of Delroy’s pulse. Weaker. In her gut she knew he had internal injuries, too, some kind of bleeding somewhere, but she couldn’t get a good feel of his belly to check for rigidity. “And I think he’s bleeding inside, so I’ll need an IV set-up ready to go once he’s out of here.”
“But he’s breathing?”
“Shallow, rapid. Do you have a blood-pressure cuff?” she called, on the off chance that Delroy’s other arm wasn’t broken and she could take a blood-pressure reading.
Within seconds, a blood-pressure cuff and stethoscope were tossed under to her. But she was on the wrong side to use them, so she scooted all the way around the boy’s head and over to the left of his body, praying that his injuries there weren’t so extensive. A quick check of his arm revealed it she was safe to use the cuff, so she fastened it on, pumped it up then took a reading. “Damn,’ she muttered, not hearing a thing. She tried it again. “Eighty over forty,” she finally called. Deathly low. She desperately needed to get an IV into Delroy, to give him fluid volume to offset the internal bleed she guessed was causing his blood pressure to bottom out. “What are my chances for an IV right now, before we move him?”
“None,” Michael called. “We’ve got assistance en route, but it’s going to take a while.”
“MAST?” Even as she asked, she knew that anti-shock trousers would not be available. Once they went onto the patient and were inflated, they tamped off the internal bleed and kept the blood pressure a little more stable.
“No.”
“Other options?”
“Is he ready to move?”
“Not until he’s stabilized. So far I’ve got a head injury, a critical break to his right arm and I have a feeling it might be compartmentalized.” Bleeding inside the bone. “And I’m thinking there could be internal damage. And I haven’t checked all of him.” The boy’s last minutes were ticking away, she feared. Moving him would almost surely kill him if she didn’t get him stabilized, yet there was no way to stabilize him under the bus. “Look, Delroy,” she said, wiggling herself close to his ear. “What I need for you to do is fight this. Really fight it. It’s going to take us a while to move you, but we’re going to get you to the hospital as soon as we can. So don’t give up. You fight this, and I promise I won’t leave you.”
“We need to get him out from under there and have him ready for when the medics arrive,” Michael called.
“Can we get the driver to move the bus?” Delroy’s best chance was to be completely away from the bus so when ambulance arrived they could get right to the emergency care, but she wasn’t willing to risk his life by pulling him out. As fragile as his pulse was now, and as shallow as his breathing had become, that would mean sure death. She didn’t know that for sure, of course, but that was her gut feeling and for now she was going to go with her gut feeling.
“It’s too dangerous. One wrong turn…. Are you’re sure there’s no room for me under there?” Michael called back. “Maybe with two of us bracing him…”
“No room.” She wished there was room, but that simply wasn’t the case. She trusted Michael out there, though. Even though he seemed so far away, she trusted his presence, trusted his judgement, trusted his opinions. He made her feel…safe, like everything was going to be fine. When that feeling finally took hold, all the panic inside her that had been bubbling up to the surface getting ready to explode simply vanished. She needed that. Needed it desperately. “Look, Michael, I know you said it’s too dangerous, but you’ve got to find someone to drive the bus off us.”
“No way in hell,” he called. “That’s crazy!”
“We’ll be fine.” Funny how she sounded like the calm one now. “There’s enough clearance room.” Barely, but it could work.
“The driver’s sitting on the sidewalk, sobbing. He can’t drive. I don’t want him to drive.”
“Then find somebody else who can. We can’t bring Delroy out in his condition, but we need better access to him. So find somebody to get the bus off us.”
“Sarah, no! That could get both of you killed if something goes wrong.”
“What kind of doctor were you before you were on the ship?” Honestly, she didn’t know, and it was an odd time to ask, but she had a hunch about him.
“Surgeon,” he yelled back.
Just as she’d thought. Nerves of steel. He was the one to do it. “You do it, Michael. You get the bus off of us. Because if you don’t…well, you know the consequences.” She waited for him to refuse, but there was no response for a minute. So she worked her way down the left side of Delroy’s body, finding what she thought was a broken femur. It just kept getting worse and worse for the poor child. “Well?” she finally called out to him.
“Look, Sarah, I don’t want to do this. But I’ve got to trust that you know what you’re doing.”
Like she trusted that he knew what he was doing.
“I was getting the keys. So now tell me what you see on the bus. Your proximity to the wheel. Clearance above you.”
Sarah gingerly rolled over on her back and looked up at the undercarriage. She wasn’t a mechanic, didn’t know what was what, but she was a good judge of distance, and this distance was much less than she’d guessed. “Eighteen inches clearance in most places. And as we lie here, the child has about twelve inches to his left, which would be the driver’s side. He’s not touching the tire, but it’s close, and I can’t get him lined up and any further away from it. Also the tires are turned to the left and the one on the driver’s side tire is sitting in bit of a pothole, so before you move you’ll have to straighten the tires or you’ll run over his leg. And his leg is already fractured, I just discovered.” Sarah drew in a steadying breath, counting, more now than ever, on Michael’s calm co
mposure to get her through this. “There’s more clearance on the right side. You’ll be fine there.” But it was so close on the left, she wondered if an inexperienced jitney driver could do it.
“And where will you be during this?”
“I’ll get back in line with his head.” That was the best place, as coming back alongside of him would only increase the risk of her getting run over. “Have you ever driven a bus, Michael?”
“No.”
“A car?”
“Yes?”
“A big car?”
“Does a big truck count?”
Sarah scooted on her left side, making her way back up along Delroy’s body, aiming for a position where they would be head to head. As she scraped her way along the rough pavement, it was only then that she realized if Michael turned even a fraction of an inch in the wrong direction, he could run over them both and there would be no one to stop him. By the time she could yell directions to someone on the outside who would yell directions to him, it could be too late. But there wasn’t another choice. Right at this moment she had to trust Michael like she’d never trusted another person in her life. And after so long of not trusting anything or anyone, it felt good. Surprisingly good.
“Look, Sarah, why don’t you come out from under there and let me see what I can do. Maybe someone else out here can drive the damned bus…”
“I promised Delroy I wouldn’t leave him, and I’m not going to?” This point was not negotiable. Amazingly, Michael didn’t argue about it, like she’d expected he might. She liked it that he listened to reason. In her estimation that made him a much better doctor than she already knew him to be because he knew the value of giving support to your patient no matter what the situation.
Now all she needed was for him to be a good driver, too.
Suddenly a flashlight scanned the area from behind her. She couldn’t turn to look at it even though she desperately wanted to see his face again. But she couldn’t get herself into that position while he assessed his so-called surgical field before he performed this most critical operation. “So, what’s your assessment, Dr Sloan?” she asked, trying to sound light about it. “Minor surgery required? Or major surgery?” After this was over, she’d need a real holiday.
“Major surgery, I’m afraid. Your bit of a pothole is a little larger than I thought, and it’s going to be a problem.”
“Meaning?”
“Meaning I’ve got to gun the engine to bump out of it. The driver’s called his company to send a qualified driver out to do this, so maybe we should wait.”
“But how long will it take for him to get here? I don’t think we have time to wait.” She listened for a moment and heard the far-off wail of a siren. The ambulance? She desperately hoped so.
“A few minutes,” he said. “Look, Sarah, this is too dangerous…”
“I know the risks, Michael. We’re running out of time, though, and I trust you to do this.” She placed her fingers to the pulse in Delroy’s neck. “So please trust me when I tell you that we have to get this done now. We’re losing ground under here.”
Michael didn’t respond for a second, but finally he exhaled in an audible sigh. “Then I guess we don’t have a choice, do we?” he said, snapping off his flashlight.
“No, we don’t.” Steadying herself for what was to come, Sarah put a reassuring hand on Delroy. “It’s almost over,” she said to the boy. “Just another minute, and they’ll have this bus off us then we’ll get you to the hospital.” She said a silent prayer that it would be soon because as she laid her hands on Delroy’s head, her fingers went to the pulse in his neck yet again. It was even weaker. Irregular now. In another few minutes there would be no pulse.
“Brace yourself,” Michael called. “I’m not familiar with the gears, so this could be a little rough. But you’ll be fine.”
She raised her head just enough to see his feet as he walked away. Well, Sarah, for someone who said she’d never work again as a doctor, you’ve sure jumped back into it in a big way.
Shutting her eyes, she laid her face to the pavement and stretched both her arms ahead of her to make contact with Delroy as the bus’s gears engaged. Then she drew in a deep breath and held it.
“Damn,” Michael muttered, climbing into the jitney driver’s seat. Of all the people in the world, it had to be Sarah under there! And why the hell hadn’t she bothered telling him she was a doctor before now?
It was odd, but he didn’t have time to think about any of it because there was a critically injured kid down there. And Sarah. And here he was at the wheel of a vehicle he’d never been inside before, let alone driven, scared to death, and ready to drive it anyway, no thanks to the real driver, who was still incoherent, getting more and more hysterical by the minute. Naturally, no one in the crowd had admitted to knowing how to drive one of these things either, of all the rotten luck. So there he was. In the hot seat, quite literally. Damn! All he’d wanted to do was come ashore for a conch fritter from Clarice’s Café and do a quick check of her daughter’s leg.
Those things didn’t take nerves of steel. This did, and as he studied the gears, trying to figure which did what, he forced himself not to think about the fact Sarah was a doctor who, for some strange reason, hadn’t disclosed that fact to him. Gears. Concentrate on the damned gears!
That’s exactly what Michael did for the thirty seconds before he jumped off the bus and dropped to his knees to tell Sarah what he’d decided. “I’m going to move the bus forward, rather than going backwards—it’ll give me better momentum to pop the wheels out of the pothole. I just wanted you to know that the entire jitney’s going to roll over you so you’ll be prepared. Oh, and after it does, I’ll expect an explanation.”
“An explanation?”
“Of why you didn’t tell me you are a doctor.”
Michael didn’t wait for her response to that. Instead, he climbed back into the jitney, sucked in a deep breath, turned the steering-wheel until the tires were straight, then depressed the clutch slowly, giving the engine enough gas to rock it, but not enough to get the tire out of the rut. He was too cautious. He knew that. But he lived cautiously these days. Still, he had to try it again, skip the caution and get it right. Sucking in yet another deep breath, Michael gave it another go, punching the gas pedal much harder this time. The bus rocked forward even harder, but still not enough. Damn it, it wasn’t going to work! To get up the momentum he needed, he’d have to practically floor the gas pedal, and in doing so, the tire would pop out. But in that moment the bus would also be totally out of his control. And Sarah… He forced that thought from his mind, replacing it with another.
“I need help,” he shouted, jumping from the jitney. “I need people to push this bus forward. Enough people to get behind and push it when I hit the gas pedal.” This would work. He knew it! “Push it just enough so that we can get the front tire out of the hole.”
Immediately, the majority of the hundred or so people who’d gathered there to watch ran to the back of the bus. Too many, of course, but he’d get a good line of men from the group, and that would do nicely. With the sound of the siren getting closer, he guessed they’d just about make it by the time the medics arrived.
“Damn,” he muttered, steeling himself for what he had to do. Battlefield surgery had been easy compared to this.
The first time the jitney engine revved, Sarah held her breath, but nothing happened. The second time, she actually looked up, saw the bus try to move forward, then sit itself back down in the hole. Delroy was struggling for breath now, and it occurred to her that if he quit breathing altogether, she was in no position to attempt any sort of resuscitation. She’d have to pull him out from under the jitney, risking injuries that might kill him to perform CPR. “Just another minute,” she said to the boy. “In fact, maybe we should count it off together.”
She glanced out to the feet of the crowd. They were running away now. She couldn’t imagine why. Clearing a way for the ambulance? It sti
ll didn’t sound so close, but she hoped the people out there were making way for it. “One. Two. Three.” She counted long, drawn-out seconds, thinking about Michael in between the protracted count, conjuring up his image, trying to find his sense of calmness. She didn’t want to get to sixty and depended on Michael’s distraction to keep her away from it because she feared that at sixty Delroy would give up for good.
Back in the driver’s seat, Michael depressed the gas pedal and the crowd at the rear started to push. It took only a second for the wheel to come out of the hole, then he inched the bus forward, deathly afraid that he lacked the proper sensitivity in his right foot to do this. Actually, his right prosthetic foot. He could drive just fine, but the reflexes governing the movement in a prosthetic leg certainly weren’t like those of a real leg, and he’d had more than his fair share of speeding tickets where he’d depressed the gas pedal too hard, trying to figure out the delicate adjustments to life without a limb. So, as sweat beaded across his forehead, he drove, hoping he was better than he gave himself credit for.
The jitney moved forward slowly and, thank God, went as straight as an arrow. At least his steering wasn’t impaired, he thought as he looked into the rear-view mirror to see if he’d cleared Sarah and Delroy yet. He’d instructed the crowd not to converge on them, and so far everybody was hanging back. But he didn’t see them yet, even though it seemed like he’d driven miles.
His hands ached from the way he gripped the steering-wheel—white knuckles all the way. And the sweat dripping down his face stung his eyes. If muscles could scream, the ones knotting in his shoulders and neck would do that as he forced the bus forward, willing himself to concentrate on the driving and not on Delroy. Not on Sarah.
